Старший помощник капитана

Описание

Requested Rank: Chief mate Availability Date (Month, Year): 08.2016
Pref. Vessel Type: Guard vessel Expected salary:
ENGLISH Language Abilities: to Speak good to Translate Text: good to Write: good
Name of Marine (Professional) St.Petersburg Marine College (Navigator)
School /College/Academy: PERIOD
(From - To):

From: 1997 To:2000
Foreign Crew Experience (specify
nationalities) Filipino Croatian German Romanian Myanmar
Other Skills                              
(specify details)
I hereby affirm that all the information provided by me in this application form is the true and correct to the best of my knowledge
Date: 09.10.2017 Signature:
SEAFARER'S APPLICATION FORM - Page 2 of 4 - LIST OF DOCUMENTS

Family Name       First Name       Rank      
A. TRAVEL DOCUMENTS, SEAMAN'S BOOKS AND MEDICAL CERTIFICATES
Document Name (Description) Document No. Country Issue Place Issue Date Exp. Date
National Seaman’s Passport Book      
Travel Passport (it’s mandatory to possess it) 63#9204246 Russia Rybinsk 26.11.2013 26.11.2018
Seaman's Book - Antigua & Barbuda
Seaman's Book - Cyprus CY100201 Cyprus Limassol 02.10.2006 01.10.2016
Seaman's Book - Germany                              
Seaman's Book - Netherlands                              
Seaman's Book - United Kingdom                              
Seaman's Book -                                    
Visa – USA (specify only if
valid)
German Working Permit (specify only if valid)                              
Visa Schengen (specify only if valid)                              
Medical Examination Report ( if valid)                              
Drug & Alcohol Test (optional)                              
Vaccination against Yellow Fever       Russia St.Petersburg 09.06.2008 09.06.2018
Passport Photos 12 pcs for deck officers and 8 pcs for other ranks are normally require to arrange flag state
documents

License Name (Description) License Grade License No. Issue Place Issue Date Exp.Date
National License (officers) OR Chief mate 1010206257 St.Petersburg 29.07.2015 06.05.2020
Rating's Watchkeeping Certificate
Functions and Level 1, 2, 3 M, 7 O                        
Limitations none                        
License: Antigua & Barbuda
License: Antigua & Barbuda GOC
License: Cyprus                              
License: Netherlands                              
License: Germany                              
License: United Kingdom         
National GMDSS Operator Certificate GOC 0057267 St.Petersburg 15.09.2010 06.05.2020
C. COURSE CERTIFICATES
Document Name (Description) Document Number Country Issue Place Issue Date Exp. Date
Radar Observer & Plotting 0025717 Russia St.Petersburg 03.07.2015 03.07.2020
A.R.P.A. 0173388 Russia St.Petersburg 03.07.2015 03.07.2020
Basic Safety Training (4 components) 0171954 Russia St.Petersburg 06.05.2015 06.05.2020
Proficiency in Survival Craft / Fast Rescue Boat 0024740 Russia St.Petersburg 07.05.2015 07.05.2020
Advanced Fire Fighting 0024590 Russia St.Petersburg 08.05.2015 08.05.2020
Medical First Aid 0025933 Russia St.Petersburg 16.05.2015 16.05.2020
Medical Care 0025933 Russia St.Petersburg 16.05.2015 16.05.2020
ECDIS 0025901 Russia St.Petersburg 24.07.2015 24.07.2020
HazMat (USA, Code Fed. Reg. 49)
HazMat (IMO Dangerous Cargo Training)
Oil Tanker Familiarization Training                              
Oil Tanker Advanced Training                              
Chemical Tanker Familiarization Training                              
Chemical Tanker Advanced Training                              
Gas Tanker Familiarization Training                              
Gas Tanker Advanced Training                              
Crude Oil Washing (COW)                              
Inert Gas System (IGS)                  
Date: 09.10.2017 Signature:
SEAFARER'S APPLICATION FORM - Page 3 of 4 - SEA SERVICE (LAST 5 YEARS)
Please indicate your sea service in the last 5 years as exact as possible - required are the actual sign-on and sign-off dates accounting to the certificates resp. seaman's book entries. To speed up processing kindly indicate phone and/or fax numbers of your previous employers. Ship sizes are to be indicated in gross tons, total engine output in kilo Watt (1 kW = 1,35 bhp) to go along with STCW limitations. Please be prepared to provide evidence for sea service that cannot be confirmed by reference check. The information provided may be passed on to our clients and to flag state administrations to allow for verification of rank experience. Please use the European date format (Date.Month.Year = DD.MM.YY).